CVS High Water Usage Checklist
Use this form to record location details, inspection results, meter readings, documentation steps, and assessment notes from the checklist.
Location Information
Location ID
*
Service Channel Tracking #
*
Plumbing and Equipment Inspections
Restroom Toilets
Yes
Restroom Sinks/Faucets
Yes
Visible Fixture Leaks
Yes
Water Heaters
Yes
Boilers
Yes
Pharmacy Sinks
Yes
Mop Sink
Yes
Pipe Fittings/Nozzles/Spigots/Threading
Yes
Roof Access
Yes
HVAC Water Lines
Yes
Irrigation
Yes
Backflow Devices
Yes
Exterior Plumbing/Piping
Yes
Equipment Make
Equipment Model
Equipment Serial Number
Equipment Manufactured Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Installation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Warranty Details
Meter Check
Meter Number
*
Meter Reading
*
Meter Movement Check
*
No movement (possible irrigation overuse)
Movement observed (possible leak still present)
Documentation and Follow-up
Completed checkboxes for detailed ServiceChannel Work Order notes
*
Yes
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of
Leak or issue location
Repair proposal if issues are identified
Assessment steps if no issues are found
Possible excessive sprinkler usage
Yes
Possible underground or irrigation line leak
Yes
Additional other notes
Submit
Should be Empty: